Let me tell you a little story of a patient who is very similar to the one you described. We had a patient at the county jail who was always complaining of chest pain. Appeared perfectly normal when we got there, and always turned out to be nothing. Three weeks ago, another unit got the call. They arrived on scene and found everything to be like always. Pt was CAAOX4, BS = and clear, SPo2 97%, HR and BP a little elevated, skin warm and dry. They determined that the patient was not having a cardiac event and transported in non-emergency...until he coded. Seems he was having an MI after all. Now we have a medic who has been suspended without pay while it is investigated, and who will probably lose his license over this. Could have been prevented if he had just followed protocol.
Hope this shows you why your way may not be the optimal way. This guy is a good medic. He just fell into the trap of thinking every cardiac patient will present in a certain way. I had a call a few months ago for a 25 year old having chest pains. No one expects a 25 year old to be having a cardiac event. This patient was a little diaphoretic, but he was doing landscaping on a warm day with high humidity so that was easily explained. He had no pertinent Hx. His vitals were normal initially, but changed enroute. We followed our CP protocol thinking initially that it was for nothing. The monitor showed no changes. Turns out he was having a RVI. Treat the patient, don't try to prove he is lying about what is going on
GazHaz, please spare me your stories and analogies. I'm not trying to be an ass but I've been a paramedic for the past 15 years, I've worked in both high volume urban settings and low and slow rural systems. I have my BS in nursing and have acted as training officer for two different departments. In short, I didn't just fall off the apple cart. I also have stories of patients who the medics thought were full of crap that ended up coding. I too have had personal experience where my initial perception with a frequent flyer ended up being wrong. So you didn’t “show me” anything other then you have no problem being condescending to someone you don’t really know.
You have also completely misrepresented what I've posted in this thread. I am NOT trying "to prove (anyone) is lying about what is going on". In fact I strongly resent the implication. I could care less if the patient is or is not lying. I never stated or even intimated that I am. What I am stating is that I will not run the chest pain protocol blindly. I will not hook every patient up ALS that I come into contact with - just in case. Once again, I am NOT a trained monkey. What the person tells me isn’t now nor ever will be the sole determining factor in how I care for a patient. If there’s one thing I’ve learned in my life and in this profession it’s that people lie all the time for almost no explainable reason. It’s not going to change how I care for them.
If I were to follow your advice, ALL calls I respond to should be ALS - you know, just in case they drop dead. In that kind of world there would be no thought process and every EMT and Paramedic would become the quintessential cookbook medic. And when that day comes will you then be defending medics that bottomed out a patient's BP with Nitro when there really wasn't any real indication that the patient needed it in the first place? Will you think its okay that we start giving out morphine, fentanyl, or other controlled pain meds to anyone that says the magic word?
In my opinion that is total backwards thinking. Maybe we should just go back to the old Johnny and Roy days and not even start an IV unless we can raise Rampart on the radio. Better yet, let's just do away with paramedics and pay Doctors to run the rigs, I'm sure they would just jump at the chance. I completely disagree with that brain dead approach to our profession which you seem to be espousing. Instead of telling medics to educate themselves and move our profession forward it seems you would rather dummy everything down.
Also you seem to be ignoring the fact that we're not giving out sugar pills here! We're administering heavy duty medications so we damn well shouldn't be giving them to people that don't really need them! Is that a smart thing to do? Isn't that negligent?
I do know one thing, if I did the follow your advice I wouldn’t be practicing in any of our local systems very long as the Medical Director would punch my ticket if I kept dumping meds into every – let’s say – questionably legitimate patient I came into contact with. Not only isn’t it “the optimal way” it’s also dangerous.
Man, I didn't want to come onto these boards and get into arguments but not only didn't I agree with your last post I honestly found it to be smug and patronizing. Sorry if this response upsets you but I have never been one to back down, especially when I didn’t throw the first punch.
- fishy, princessmedic, CHASgirl6204 and 2 others like this